Elimination summer 2012

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Elimination summer 2012

  1. 1. ELIMINATION P&A
  2. 2. I drink too much. The last time I gave a urine sample, it had an olive in it.Rodney Dangerfield
  3. 3. Quick Anatomy Moment Kidneys Ureters Bladder Urethra
  4. 4. Urinary EliminationUrine formation Filtration – filters blood - does not filter out RBC’s & protein Reabsorption – as needed Water, electrolytes, glucose Secretion H,K ammonia, creatinine, uric acidMicturition
  5. 5. Normal Urine Volume – approx 250ml-400ml per void - normal production 30ml/hour -1200-1500cc for average adult per 24 hours - 500-600 newborns Color light yellow Clarity clear without sediment Odor no odor
  6. 6. Factors Affecting Urination Fluid Intake – influences output and frequency Hypovolemia- loss of fluid Nutrition – food content, salt, ETOH, caffeine Body position – work with gravity Cognition – dementia/confusion, stroke
  7. 7. Factors Affecting Urination (cont.) Psychological factors – stress, running water, warm water, privacy Obstruction – anatomical, disease process Infection – E. coli Medications – diuretics
  8. 8. Altered Urinary function Dysuria Polyuria Oliguria Urgency Frequency
  9. 9. Altered Urinary function (cont.) Nocturia Hematuria Pyuria Urinary retention
  10. 10. Incontinence Stress increased abdominal pressure Functional unable to get to bathroom Total continuous, involuntary
  11. 11. Diagnostics Random specimen  Clean catch - does not need to be sterile - sterile - into container or nun’s cap - three wipes
  12. 12. Diagnostics (cont.) 24 hour  Catheter sample -kidney function - sterile - must include all urine - straight cath or indwelling - timing
  13. 13. Collecting urine from young children Catheterization not recommended Use of collection bag
  14. 14. Tests Specific gravity - weight or concentration of urine compared to water - urinometer - normal adult 1.010 – 1.025 Reagant strips - dipped in urine - measures substances in urine such as glucose, proteins & ketones
  15. 15. Tests (cont) Urinalysis - most common - 20cc-30cc sample Urine C&S - identify microorganisms - 24 to 48 hours - often related to antibiotic use
  16. 16. Urinary Health Promotion Intake UTI’s Muscle tone
  17. 17. Urinary catheters Indications -inability to void, accurate measurement, irrigation, comfort Types - straight, indwelling (Foley), triple lumen Risks - infection, trauma
  18. 18. Straight catheterization Wash hands Check pt ID Explain procedure Position patient Open kit Bottom drape Sterile gloves Top drape Pour betadine on cotton balls Open lubricant Nondominant vs dominant hands Insert and advance Sample if needed Reposition patient, remove gloves, wash hands document
  19. 19. Indwelling catheterization Wash hands Check pt ID Explain procedure Position patient Open kit Bottom drape Sterile gloves Top drape Test balloon Pour betadine on cotton balls Open lubricant Nondominant vs dominant hands Insert, advance & inflate balloon Sample if needed Reposition patient, strap to leg, remove gloves, wash hands document
  20. 20. Indwelling catheter (Foley)
  21. 21. Nursing Responsibilities Placement and removal Assessment Sample collection Troubleshoot Irrigate when needed
  22. 22. Bladder irrigation
  23. 23. Other types of urinary cathetersSuprapubic Nephrostomy tubes Condom Catheter
  24. 24. Other related urinary componentsDialysis  Bladder scannerHemodialysisPeritoneal dialysis
  25. 25. Bowel Elimination
  26. 26. Factors Affecting Bowel Elimination  Nutrition - fiber - lactose intolerant - gluten  Fluid intake - 75% water - ↓fluid intake  Hemorrhoids - enlarged varicose veins  Medication - narcotics - Fe - antacids
  27. 27. Altered bowel function Constipation - infrequent, painful, hard, dry Fecal impaction - accumulation in rectum - digital disimpaction Diarrhea - ↑ motility - medication Incontinence - involuntary Distention - inactivity Disease process - Crohn’s disease, Cystic Fibrosis
  28. 28. Diagnostic tests Specimen  Radiologic - stool only - x-ray image of opaque substance - barium, laxatives, enemas, - procedure NPO Occult blood  Endoscopy - Guaiac or Hemoccult - visualization of internal - procedure structures -EGD (esophagogastro Culture duodenoscopy) - atypical intestinal organisms - procedure, O&P http://www.youtube.com/watch?v=_qrbzpDA98g&feature=related
  29. 29. Specimens
  30. 30. Checking for Occult Blood http://www.youtube.com/watch?v=Pc3MtqUwFwE
  31. 31. Colonoscopy http://www.youtube.com/watch?v=W0fjO0rsCIw
  32. 32. Enema Purpose – cleansing of large bowel Small Volume - commercially prepared, oil or water, approx. 150cc Large Volume - warm tap water or saline, - 1000cc for adult, 240cc-350cc for child, 15cc-60cc infant Return Flow - flatus - 300cc-500cc - repeat as necessary
  33. 33. Enema Procedure Wash hands ID patient and explain procedure Fill bag with fluid Place patient in left lateral position Place chux Insert lubricated end of enema tubing 3-4 inches into rectum Hang/hold enema bag 12-18 inches above patient Place on bedpan or BSC or eventually bathroom Make patient comfortable Wash hands Document
  34. 34. Fecal Diversion Procedure Ostomy Ileostomy Colostomy - temporary or permanent - irrigation - clothing - unusual circumstances
  35. 35. Stoma
  36. 36. Types of Colostomies Ascending  Descending Sigmoid
  37. 37. Types of Colostomies (cont.) Transverse
  38. 38. Care of the Colostomy Assessment - pink, no pain, flush to skin Cleaning - soap and water Bag changing - disposable vs reusable Emotional support

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